As can be seen from its high mobility and number of joints, the hand is a limb with a complex structure. This high mobility is due to the perfect skeletal system of the hand and the muscle and tendon systems on this system.

In addition, the structure that provides the flexibility and functional strength of the hand is thanks to the existing perfect blood circulation and flawless nervous system network In addition to these structures, there are formations such as connective tissue bands (ligaments), subcutaneous tissue, skin and nails, which are supportive.
The Hand Surgery Department deals with the wounds, losses and diseases of this whole system, namely our hand. Hands, which we use almost everywhere in our daily life, are often injured. If the loss of skin and soft tissue covering the top of the hand is not treated, the damage gradually grows and there is loss of function and sensation. If the tendons, nervous system network, joint capsules, joints and bones are not protected with appropriate treatments, the problems may grow and reach irreversible stages.
The severity and duration of the injury to the hands causes aggravation of the damage. If not treated with appropriate timely intervention, events such as inflammation and necrosis will increase soft tissue damage.
Systemic or local diseases affecting the wound healing period may cause hand injuries to reach more severe stages and tissue loss. Even a simple uncomplicated hand injury can become a more difficult problem for people with chronic diseases, diabetes, smokers, or those with circulatory problems.

CLINICAL APPROACH

The first approach to the injured hand is to start the necessary diagnosis and treatment processes by providing hemostasis (appropriate bleeding control) and keeping the hand in a physiological position without further damage. Tissue defects should be closed as quickly as possible. Hand contaminated. If it is not infected or heavily soiled, it should be washed and cleaned only with saline or lactated Ringer’s solution. If there is heavy contamination, the hand can be cleaned with antiseptic solutions, but then the antiseptic solution should be removed from the wound with physiological serum. Open wounds with tissue defects should be closed with a method suitable for the relevant tissue. If a suitable permanent closure method cannot be performed, the wound should be covered with temporary synthetic or biological dressings and the underlying exposed structures should be protected. Then, a permanent closure attempt is made under suitable conditions. In hand surgery, tendon, nerve, vessel and joint repair, broken bone repair, post-burn repair and repair of skin wounds are often performed. The development of medical technologies and hand surgery has greatly increased the efficiency of treatment in eliminating loss of function and visual impairment even in serious injuries.

Among the surgical techniques currently used are:

Grafting

The transplantation of skin, bone, nerve or other tissues from a different part of the body to the damaged area in order to repair the damaged area is called grafting.

Flap Surgery

Flap surgery is the transfer of the skin from a suitable and healthy part of the body to the damaged area together with the underlying fat tissue, blood vessels and muscle tissue. In most of the hand surgeries performed, the lost sensation and function can be regained with supportive rehabilitation applications, although it sometimes takes a very long time.

CARPAL TUNNEL SYNDROME AND TREATMENT

It is the most common condition among the nerve compressions, which occurs as a result of the compression of the median nerve, which has an important role in the movement and sensation of the fingers of the hand, in the wrist region. The space through which the median nerve passes through the wrist is called the carpal tunnel. Prolonged exposure of the Median Nerve within the carpal tunnel causes carpal tunnel syndrome.

What Are the Symptoms of Carpal Tunnel Syndrome?

• Loss of power felt in the hand
• Feeling of fatigue quickly
• Tingling sensation in fingers
• Numbness in fingers

Pain and drowsiness may be felt at a high threshold at night, waking from sleep. In such cases, moving the wrist can reduce the pain. In very advanced cases, melting of the thumb muscles, resulting in weakness and loss of sensation are seen. Loss of sensation in the fingers may cause injury (burning, cutting, injuring) to the fingers of the patient, since there is no feeling of pain and pain.

What is the Treatment for Carpal Tunnel Syndrome?

In the initial period, limiting the mobility of the wrist and using anti-inflammatory drugs can reduce complaints. In cases where improvement is not observed for 1-3 months and continues despite the precautions taken, surgery is required. The carpal tunnel is reached with a small incision at the appropriate point between the palm and the wrist, and the carpal tunnel is opened by cutting the roof of the tunnel completely. In advanced cases, neurolysis, that is, nerve release, is performed under the microscope. In this way, the pressure that causes complaints is removed. Complaints do not disappear immediately after surgery. In fact, complaints may increase as the compression in the nerve will continue due to the swelling that occurs after the surgery. The healing process can vary between 3-6 months. In some severe and delayed cases, although the complaints may decrease after the surgical procedure, they may not fully heal. Factors such as smoking, irregular-inappropriate diet and advanced age affect the treatment results negatively.

RHEUMATOİD ARTHRİTİS

It is a serious disease that limits the appearance and function of the hands and other parts of the body, and can be crippling. It often deforms the knuckles, restricting movement and forcing the fingers to stay bent.

Conditions caused by rheumatoid arthritis can usually be treated without surgery. Appropriate physical therapy applications to be applied with special devices are an effective treatment method. For some cases, surgery is the best solution. The operation decision should be made by the joint decision of the surgeon who will perform the operation and the rheumatology specialist. In surgical treatment, tissues are removed from inflamed joints, tendons are replaced, or artificial joints are placed. Although the hand cannot be used fully after the operation, a significant improvement is observed in terms of function and appearance. It should be noted that the surgery to be performed does not cure the underlying disease. Rheumatoid arthritis may continue to cause damage and sometimes reoperation may be required.